Presentation given by Arogya World CEO, Nalini Saligram, PhD, at the Geneva Health Forum - PS 07 School based interventions to tackle NCDs

1. Changing the Course of Chronic Disease,
One Community at a Time
School-based diabetes awareness and
prevention education in India
Nalini Saligram, Ph.D.
18 April 2012
Geneva Health Forum
PS 07 School based interventions to tackle NCDs
Arogya World is a U.S. based non-profit 501 © 3 organization. The name of the organization is simply an articulation of
our mission: Arogya in Sanskrit means good health. More literally it means to live a life without disease.

2. Diabetes At Catastrophic Levels in India
 50 million. 87 million by 2030 (IDF). India #2.
• Urban India prevalence 11 – 12% now vs. 3-4% in the „80‟s
 Diabetes kills 1MM Indians/yr (2010, IDF).
 Indians get diabetes 10 years earlier than in the West
• >1.1 billion people, 50% < 25 years = alarming public health crisis over the next 20 years
 Healthcare costs skyrocketing
• Low-income family spends 25% of income on diabetes care for 1 adult (IDF).
• Diabetic foot ulcers result in 200,000 amputations/year, each costs >$10,000.
• India bears heaviest costs of diabetes = 2.1% GDP, $2.8 billion or 11% of total health
expenditure in 2010. Increase to $4.8 billion in 2030.
1 person is diagnosed with diabetes every 5 seconds
1 person dies from the complications* of diabetes every 10 seconds
1 limb is amputated because of diabetes every 30 seconds
*Complications of diabetes include heart disease, foot ulcers, eye disease, kidney disease etc.
© 2010 Arogya World. All Rights Reserved. 2

3. Prevention: The Holy Grail for Tackling NCDs
 WHO: a healthy diet, exercise and avoiding tobacco can prevent
• 80% of premature heart disease
• 80% type II diabetes
• 40% of cancers
Compelling Clinical Proof Exists that Diabetes Can Be Prevented
 Landmark Trial - Diabetes Prevention Program (DPP)
• 3234 high-risk adults in the US. 30 min physical activity/ day + low-fat diet reduced
chance of getting diabetes by 58%, (metformin: 31%) NEJM Feb 7, 2002.
• The Lancet (2009) …diabetes prevention through lifestyle changes sustained 10 years.
 Finnish Diabetes Prevention Study
 NEJM May 3, 2001.
 Indian Diabetes Prevention Programme
 Diabetologia. 2006 Feb;49(2):289-97.
© 2010 Arogya World. All Rights Reserved. 3

4. The Arogya World Approach to the NCD Crisis
Two-fold mission
Galvanize global action to address Implement Diabetes Prevention
non-communicable diseases (NCDs) through Lifestyle Changes in India
► Leverage UN NCD Summit Sep 2011
► Op-ed, blog and social media campaign ► Multipronged Approach in schools,
► Case studies workplaces and the community
► Women and NCDs ► Leverage technology and partnerships for
► Women for a Healthy Future Petition scalable, cost-effective programs
► 10,000 Women “Perspectives on NCDs” ► Science-based work
Global Survey ► Measure effectiveness and impact
© 2010 Arogya World. All Rights Reserved. 4

5. Our Whole-of-Society Approach in India:
Diabetes Prevention with Lifestyle Changes
Community Policy
► mDiabetes: Mobile health outreach – text ► Interact with Policymakers to aid diabetes
messages on diabetes and prevention to prevention.
1 million consumers in 12 languages.
With Nokia. CGI commitment in 2011.
Schools
► Diabetes Awareness & Prevention
Workplace
► Healthy Workplace Seal of Approval
Education. Teacher/peer-led, 2000
► Build capacity for Lifestyle Interventionists
middle school children Delhi 2011.
► Clinical trial (DPP) based 16 week
► Healthy Schools Seal of Approval
diabetes prevention modules
Year-long Media and Thought-leader Engagement and Advocacy
© 2010 Arogya World. All Rights Reserved. 5

6. Our Schools Work in India
 Initiated in 2011 in partnership with Hriday, a youth NGO in India
 Trained Teachers & peer-leaders. Based on previous MYTRI model.
 Reached 2,000 children in 6 and 7 grades (11-13 years old).
 6 schools in Delhi – 3 government, 3 private.
 5 classroom-based interventions. Age appropriate educational modules.
 Pre- & post intervention surveys.
 Analysis completed; results are in.
 Encouraging awareness and behavior change trends.
 Supported by Merck/MSD India.
 Second year intervention in the same children will help behavior
changes “stick”.
© 2010 Arogya World. All Rights Reserved. 6

7. First Results

8. Awareness and Knowledge Improved
Unhealthy Eating Increases Physical Inactivity Increases
100 Risk for Diabetes Risk for Diabetes
90
100
80 90
70 80
60 77.2 70
50 65.4 60
40 50 61.3
50.1
40
Baseline Year 1
Baseline Year 1
Diabetes Complications Diabetes is Preventable
Knowledge 100
100 90
90 80
80 70
70 60
60 73.2 50
50 67.3 40 50.7
42.1
40 30
Baseline Year 1 Baseline Year 1

9. First Signs of Behavior Change
Unhealthy Food Consumption Reduced
Carbonated Fried Snacks
40 Drinks
35 40
30 35
25 30
20 25
15 20
10 15
15.6 10
5 8.9
0 5 9.8 7.8
0
Baseline Year 1
Baseline Year 1
Sweets Chips
40 40
35 35
30 30
25 25
20 20
15 15
10 10 21.4 18.8
15.3
5 10.3 5
0 0
Baseline Year 1 Baseline Year 1

10. More Exciting Evidence of Behavior Change
Children Consistently Chose Healthier Foods
Lemonade over Soda Fruit chaat over Aloo Tikki
100
100
80
80
60
60
40 75.1
62.6 40
20 60.3 68.9
20
0
0
Baseline Year 1
Baseline Year 1
Rajma Rice over Chole
Poha over Samosa Bhatura
100
80 100
80
60
60
40
63 40
50.8 57 64.3
20 20
0 0
Baseline Year 1 Baseline Year 1

11. Back-Up

12. Arogya World Network of Influencers
Board*
Dr. Nalini Saligram – Arogya World; Dr. Pamela Yih, Treasurer – Pamela Y-F Yih Inc.; Kathryn Graves – Emory Univ
Rollins School of Public Health; Dr. MeryleMelnicoff– formerly at WISTAR Institute
Indo-US Scientific Steering Committee*
 Based in India - Dr K. Srinath Reddy – President, Public Health Foundation of India, Dr V. Mohan – Madras Diabetes
Research Foundation, Dr Ashok K. Das – Additional Director General Health Services, Dr Prabhakaran – Centre for
Chronic Disease Control, and PHFI, Dr Nikhil Tandon – All India Institute of Medical Sciences, Dr. Prasanna Kumar –
Bangalore Diabetes Hospital
 Based in the US - Dr K.M. VenkatNarayan – Emory University, Dr Sreekumar Nair – Mayo Clinic, Dr Francine
Kaufman – Medtronic, Dr KarmeenKulkarni – Abbott Diabetes Care, Dr Sethu Reddy – Merck, Dr. Om Ganda -Joslin
Advisors*
Dr A Ramachandran - India Diabetes Research Foundation, Chennai; Dr SubhankarChowdhury-IPGME&R and SSKM
Hospital, Kolkata; Monika AroraHriday-Shan; C.V. MadhukarPRS Legislative Research; Deanna M. HoelscherMichael
and Susan Dell Center for Advancement of Healthy Living; Dr Sudeep Singh Gadok, International Health and
Development Expert; Raj Dave ARE Consulting, Dr. ArunChockalingamWorld Hypertension League, Dr. David C
U’PrichardDruid Consulting
Behavior Change Task Force*
 Based in the US - Dr. Fran Kaufman, Medtronic, Dr. LinelleBlais, Emory University, Andrea Falls, Edelman
 Based in the UK – Zoe Hellman, Weight Watchers
 Based in India – Dr. Ranjani Harish, Dr. Mohan‟s Diabetes Specialities Centre, Dr. Monika Arora, Hriday-Shan,
SukantiGhosh, APCO Worldwide, Dr. KanavKahol– PHFI
*all working pro-bono
+
Consultants
TheaJoselow (Washington DC – digital media expert), Dr. S Kumar (Bangalore - senior consultant India), Dr.
SandhyaRamalingam (Bangalore – market research expert), Beau Young (Philadelphia- accountant)

13. Our Track Record
• Feb 2009 – Workshop with 66 stakeholders in Delhi to gather input on priorities.
• World Diabetes Day 2009; 40 community walks in Delhi; 6,000 children asked MrsGursharanKaur, wife of Prime Minister
of India, for help in making policy changes
•Formalized as US-based non-profit organization March 2010.
•New Diabetes Friendly Recipe Created for Arogya World by celebrated Manhattan chef from Devi Nov 2010
•Initiated Schools diabetes education program in India 2011; completed year 1 program, encouraging results
•Clinton Global Initiative Commitment 2011 – 1 million consumers diabetes mHealth campaign in India; 30,000 consumers
received messages through March 2012.
• Healthy Workplace Stakeholder Input Session in India Bangalore, Feb 24, 2012
•Women for a Healthy Future – 2011 petition;